Healthcare Provider Details

I. General information

NPI: 1013304377
Provider Name (Legal Business Name): KAREN SUMNER RNFA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2015
Last Update Date: 04/24/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3256 ARIES CT
MADERA CA
93637-8625
US

IV. Provider business mailing address

3256 ARIES CT
MADERA CA
93637-8625
US

V. Phone/Fax

Practice location:
  • Phone: 760-731-0313
  • Fax: 760-731-0414
Mailing address:
  • Phone: 760-731-0313
  • Fax: 760-731-0414

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License Number401658
License Number StateCA

VIII. Authorized Official

Name: KAREN G SUMNER
Title or Position: PRESIDENT
Credential: RN, BSN, RNFA
Phone: 760-731-0313